Without treatment the brain will be
damaged as pressure inside the skull enlarges the ventricles, causing compression and, ultimately,
death of sensitive brain tissues.
Hydrocephalus and Ventriculo-Peritoneal Shunt
The brain floats in a protective cushion of cerebrospinal fluid (CSF). It also surrounds the spinal
cord and fills open spaces (ventricles) inside the brain. The amount of CSF that circulates around
the brain normally stays the same, replenished by the body, and helps to maintain a constant pressure
inside the skull, known as intracranial pressure (ICP).
Hydrocephalus, which means "water brain" occurs when too much CSF accumulates within the
ventricles of the brain and increases intracranial pressure. Unfortunately, increased pressure within
the colosed, rigid box of the skull cannot be released on its own by the body. Sometimes a shunt is
necessary to relieve pressure on the brain from the excess fluid.
Without treatment the brain will be
damaged as pressure inside the skull enlarges the ventricles, causing compression and, ultimately,
death of sensitive brain tissues.
Surgery is preformed to treat hydrocephalus directly, by removing the cause of CSF obstruction, or indirectly, by implanting a device that can "shunt" the excess CSF elsewhere in the body where it can be tolerated - most often into the abdomen. Once inserted, the shunt usually remains in place for life (with periodic adjustment) and continuously regulates intracranial pressure.
The Operation
After a general anesthetic is administered, the patient is positioned on his back, with his head turned
to one side. The hair over the scalp incision area is then clipped and shaved.
Usually two incisions are made: a small incision in the abdomen and a curved incision in the scalp.
The scalp flap is then turned back to expose the skull, into which a small burr hole is drilled. This
uncovers the dura, the brain's covering, over the enlarged ventricles.
The shunt is inserted first into the abdominal incision and is brought beneath the skin over the
abdomen, chest, and neck, into the scalp opening.
After the tubing and reservoir are in place, a small cut is made in the dura and a ventricular tube is
inserted into the brain's right ventricle. The reservoir is then attached to the ventricular tube and is
fitted into the opening in the patient's skull.
After surgery the shunt system is completely inside the body and often cannot be felt.
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